Healthcare Trust: Bespoke Treatment

Health Solutions

May 11, 2015

We helped a troubled Healthcare Trust to reform its culture, operations and finances so that its future became more secure.

2014 – Present

Situation

Early in 2014 we were contacted by a troubled NHS Hospital Trust operating two hospitals. The terms of its licence stated that it had to manage its finances every financial year, but the management could already see that this was unlikely to happen in 2014-15. They weren’t looking for a one-off fix, but for advisers who would work alongside their teams, give them the skills they needed, and fundamentally improve their entire operational performance.

FTI Consulting's Role

We identified some big problems. The trust’s approach to financial management and operations had been to take things one year at a time. That had led them to piecemeal, one-off initiatives which had plugged gaps short-term but had done nothing to stop problems reappearing later and which left the trust vulnerable if expected income did not materialise. For example, if they were running two clinics per month, each of which was half-full, they had found extra income each year to cover the costs, but had not asked themselves whether it would be better to change to one clinic per month.

To fix this, we worked with every team in the trust. We asked them what opportunities they had spotted but not followed through, added our own suggestions, and then worked together to translate all of those ideas into concrete plans. We carefully modelled all of these in advance – there is no point introducing a text message reminder system, for example, if most of the patients involved are elderly and don’t have mobile phones. We also clearly identified the benefits, which helped everyone involved to understand them and play their part in making the necessary changes.

The trust also needed to change its approach to staff costs, which took up a large share of its budget. Few controls or guidelines were in place to ensure a planned approach to advertising vacancies or employing temporary staff, who are of course more expensive than permanent ones. We also introduced a weekly panel to scrutinise all vacancies, remove unnecessary ones and ensure that the rest were filled quickly and cost-effectively.

Although operating across two sites greatly increased the trust’s overheads, this can also bring advantages if resources are used effectively. So we looked in great detail at what activities (e.g. theatres, outpatients, electives) should take place at each site in order to make better use of resources and avoid wasting staff time travelling between the two hospitals.